title: Urinary tract injury at the time of laparoscopic and robotic surgery: presentation and management.
abstract: OBJECTIVE
  To report a series of urinary tract injuries resultant of laparoscopic or robotic procedures performed for a gynecologic indication.
  
  
  METHODS
  We identified 16 patients with urinary tract fistulas after laparoscopic or robotic gynecologic procedures between 2009 and 2012. We extracted demographic data and prior surgical data as well as reviewed our management of each case.
  
  
  RESULTS
  Thirteen subjects had undergone robotic procedures, 2 traditional laparoscopies, and a single-port laparoscopy with time to presentation from 2 days to 9 months postoperatively. Seven patients presented with vesicovaginal fistulas (43%), of which one healed spontaneously. Eight patients had ureterovaginal fistulas. Two patients (25%) were managed with ureteroneocystotomy, 2 patients (25%) were managed with Boari flap, and 4 patients (50%) were managed with double-J stent placement. One patient had a vesicocervical fistula managed via trachelectomy and partial cystectomy.
  
  
  CONCLUSIONS
  The authors have seen an increase in referrals for urinary tract fistulas in minimally invasive surgery. It is imperative to investigate the effect of a steep learning curve, unfamiliarity with new energy sources, or poor patient selection as contributing factors.
authors.affiliation: Division of Female Pelvic Medicine and Reconstructive Surgery, The Christ Hospital, Cincinnati, OH 45219, USA. tinygynie@gmail.com
authors.forename: Janelle Morgan
authors.initials: JM
authors.lastname: Evans
authors.forename: Mickey M
authors.initials: MM
authors.lastname: Karram
authors.forename: Ayman
authors.initials: A
authors.lastname: Mahdy
authors.forename: Daniel
authors.initials: D
authors.lastname: Robertshaw
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D012371:Robotics; D014548:Urinary Fistula / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D014551:Urinary Tract / Q000293:injuries*; D014591:Uterine Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery